October 31, 2012

Small Angle Well Controlled Intermittent Exotropia

It's a mouthful, to say the least. Several months ago, in June, I began noticing that Olivia's right eye was tracking outward. At first, I thought I was crazy. I thought I was tired or that my declining vision was playing tricks on me. Then I saw it again. And again. And again. 

I asked Matt if he was seeing what I was seeing, and he wasn't. I called Olivia's pediatrician anyway, who said that this sort of thing is common in children her age, and even more common among preemies. Dr. Shoyer suggested we see a pediatric ophthalmologist and recommended Dr. Mellott who is part of the same practice. We took Olivia to see Dr. Mellott in June, and after a difficult exam (by difficult I mean Olivia wouldn't hold still and/or stop screaming long enough to open her eye) she decided that since she hadn't seen the eye turn, we should wait and see if I kept noticing it or if it went away. She asked us to follow up in 4 months if it continued or got worse. 

As the summer went on, I kept noticing it happening. Matt eventually started seeing it too. The first time he said, "her eye is stuck outward!" I breathed an enormous sigh of relief....which seems strange. Of course, I wasn't relieved that there was something going on with my daughter's eye, I was relieved that staying home all day with two kids wasn't actually driving me crazy. The problem worsened as the summer went on. It was noticeable anytime she was tired, or angry, or crying, or sleepy. Sometimes it would just happen out of nowhere, when she was perfectly fine. I noticed it a lot on our trip in Salt Lake. When we got back to Boston, I called Dr. Mellott's office and made an appointment for a follow-up for October.

I took Olivia (and Sophie, obviously) in to have her eye checked again, and this time we were with the doctor long enough for her to see the eye turn. She said, "well, she definitely has a small angle well controlled intermittent exotropia.....which means that her eye tracks outward". She didn't offer much in the way of an explanation of this diagnosis (I don't much care for this doctor as a pediatrician....she's not very good with kids) but did tell me that in about 1/3 of patients it goes away with or without treatment, for about 1/3 of patients there is no change, and for about 1/3 of patients the condition worsens despite treatment. In the case of this last circumstance, surgery is typically the option that patients (really parents) choose in order to correct the issue. The issue here being that most parents don't want their kids to grow up with a lazy eye and endure teasing and bullying throughout their school years. Thinking about this presents a whole dilemma that I won't get into with this post. 

The doctor's treatment instructions were:

Patch the left eye (her good eye) 2 hours per day for one month to see if this helps the control. Apparently this condition is about muscle control rather than muscle strength. My first thought "yeah right, lady". Her alternate instructions included filling a prescription for an eye drop medication called Atropine. We ended up doing this because I knew there was no way I was going to get my squirmy, sensitive, stubborn child to wear an eye patch for two hours ever day! Choosing this option means that Matt has to pin her down while I cram her eye open far enough to squeeze one drop in each week. It immediately dilates her pupil, and she's fine right afterwards, although she is excellent at screaming and writhing while we're trying to get it all done.

Right now we've settled on giving Olivia the eye drops once a week and seeing how her eye does with this treatment. So far, I haven't noticed a big slip...it seems to be working. While she has the drops in her system, though, her pupil is dilated pretty much for the entire week. Whenever we go outside, I give her her sunglasses to put on. It's a good thing she enjoys wearing these (she often asks to wear them inside the house). 

These photos are from our first trip to the park the morning after her first eye drop treatment. I'm still concerned that this may not work for her, but right now, her vision doesn't seem to be greatly affected, if at all (it's so hard to tell in a toddler who can't communicate!), and she's otherwise happy and healthy. And so cute in her sunglasses!

1 comment:

  1. She's so beautiful that noone would ever know anything's wrong with her eye. I'm glad that you're observant and proactive with it though. Hopefully it will clear up and there will be no surgery needed in the future. Cute pictures.